Medical Evaluation Process Getting Fresh Look

By Donna Miles
American Forces Press Service

April 12, 2007 – Less than two months after a roadside bomb took both his legs during a reconnaissance patrol near Iraq's Syrian border, Marine Corps Cpl. Dylan Gray is preparing for his first encounter with the Defense Department's medical evaluation process. Recently transferred from the National Naval Medical Center, where he underwent a long string of surgeries, 23-year-old Gray is undergoing rehabilitation here at Walter Reed Army Medical Center. He hopes to get transferred to Brooke Army Medical Center in San Antonio, closer to his native Utah, to finish his treatment.

For now, Gray said he's focusing solely on his medical treatment, not to what's down the road for him, or whether he'll be able to continue his military career. "It's just too soon to worry about that," he said. "Right now, all I am going to think about is healing."

Air Force Staff Sgt. Eric Ezell has had a little more time to contemplate the medical board he expects to review his records during the next several weeks. He's hoping beyond hope that it will give him the green light to continue his five-plus-year Air Force career.

Ezell, an aerial gunner with the 20th Special Operations Squadron, was participating in a mission to infiltrate a hostile landing zone in Iraq when he got shot in the back of his head in late December. The bullet exited through his right eye, destroying the eye and fracturing the bones of his eye socket.

Ezell went through complicated surgery that involved taking bone from his leg to repair the structural area around his eye socket so he can eventually receive a prosthetic eye. He reached a major milestone earlier this months when he was discharged from Walter Reed to rejoin his unit at Hurlburt Field, Fla.

But what he most looks forward to, he said, is getting back to full duty and resuming his career.

The one hurtle that stands in the way is the DoD Disability Evaluation System -- the system used to determine if sick or wounded troops are fit for duty and, if not, how to compensate them for their disabilities.

The concept dates back to the Civil War, when Congress established the first disability retirement system for wounded officers. Nearly 150 years later, some 25,000 soldiers, sailors, airmen and Marines-officer and enlisted, active-duty and reserve-component-are included in the system, officials in DoD's manpower policy office told American Forces Press Service.

In fiscal 2006, those numbers broke down to more than 13,100 soldiers, about 5,700 sailors and Marines and more than 4,100 airmen.

Despite common assumption, only 15 to 20 percent of those in the system were wounded in combat. The vast majority of the cases stem from non-combat accidents, illnesses and other medical conditions, officials explained.

The Disability Evaluation System is actually a two-step process. It begins with a medical evaluation board that decides if a servicemember is fit enough to remain on duty. If not, the board passes the case to a physical evaluation board, which determines the extent of the disability.

That finding determines if the servicemember qualifies for retired pay and military benefits such as health care and base privileges for life, or a one-time severance payment with no additional benefits.

If the rating is less than 30 percent, the servicemember may be discharged with severance pay. Those rated 30 percent or higher are medically retired. In some cases, troops are put on a temporary disability retired list for up to five years.

Not all troops -- especially those rated at less than 30 percent disability -- are happy with the findings, a defense official said. "It's understandable, when you have so much at stake, that not everyone is happy," he said.

They can appeal their cases, but once they finish those appeals, the case is closed, he said.

A complicating factor is that several federal agencies, particularly DoD and the VA, have totally different gauges for their disability findings, he said. After DoD declares a servicemember unfit and assigns a disability rating of 20 percent, for example, VA may give a far higher disability rating, sometimes as high as 70 percent.

"That's because VA looks at disability differently than we do in DoD," the official said. "We look at it in terms of a soldier being fit or unfit, based on their ability to do the job. VA has a much wider scope. They are looking at disability in terms of a lifetime of earnings.

"We compensate for a career cut short. VA is looking at a lifetime of earnings," he said. "But a lot of servicemembers don't understand the different perspectives."

Differences like this create a lot of confusion and may signal the need for a national review of disability programs, Deputy Defense Secretary Gordon England said during testimony today before the Senate Armed Services and Veterans Affairs committees. "It may be time to cast a wider net and look at this whole area of disability," he said.

England joined other defense and Department of Veterans Affairs leaders briefing the senators about how ongoing reviews of the medical and disability systems are progressing.

No fewer than seven different task forces, both within DoD and independently run, are examining the Disability Evaluation System to make it as expeditious, easy to understand and, most of all, fair, for servicemembers like Gray and Ezell, officials noted.

President Bush appointed a Commission on Care for America's Returning Wounded Warriors, which is conducting a comprehensive review of this and all other aspects of care being provided to wounded warriors.

Defense Secretary Robert Gates appointed an Independent Review Group to examine issues throughout the military medical system, as well as the way it processes troops through the Disability Evaluation System.

David S.C. Chu, undersecretary of defense for personnel and readiness, has also directed a group to assess the Disability Evaluation System process and recommend ways to ensure "a dignified, equitable and seamless transition to civilian society for our wounded warriors unable to return to duty," he noted in a recent letter to U.S. Sen. Jim Webb.

Acting DoD Inspector General Thomas F. Gimble and his staff also began reviewing DoD's Wounded Warrior Transition Program earlier this year, at Chu's request, and are expected to report their findings to him soon, Chu reported.

Meanwhile, each of the military departments has initiated internal reviews of their processes to come up with ways to make them smoother, less bureaucratic and more responsive to the people they affect, Chu said.

Another goal is to ensure disability cases move quickly, but not so quickly that they're rushed, a defense official explained. Most cases are processed within 70 days, he said, but particularly complicated ones take longer.

England told the senators DoD is committed to improving its systems to serve wounded troops, including those involved in the medical evaluation process. "The very top priority of the Department of Defense is taking care of our men and women in uniforms and their families, and in particular, those who have made the greatest sacrifices for our nation," he said.

Those words are reassuring to Ezell, who, with two or more surgeries still ahead, is preparing for the medical evaluation process to determine if he can remain in the Air Force.

"My case is pretty cut and dried, and it's pretty much a given that my eye is not coming back," he said. "But I've got good vision in my left eye, so there's still a lot that I can do. I can't do a flying job, but I can cross-train into a whole lot of other jobs."

Ezell said he hopes the board will allow him to explore those new possibilities.

"The military has offered me a lot and given me a lot of opportunities, and I've already established a foundation that I can continue to build on," he said. "I'm hoping they'll give me the chance to do that."

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