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Evolution of Department of Defense Disability Evaluation and Management of Posttraumatic Stress Disorder and Traumatic Brain Injury

Overview of Policy Changes, 2001–2018

by Molly M. Simmons, Carrie M. Farmer, Samantha Cherney, Heather Krull

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Research Questions

  1. What were the major changes to DES between 2002 and 2018?
  2. What solutions were proposed to address problematic aspects of the disability system, and how were they implemented?
  3. How did understanding of PTSD and TBI change between 2001 and 2018, and how did this alter disability evaluation for these conditions?

For almost two decades, the United States has been engaged in continuous combat operations in Iraq, Afghanistan, and other theaters. Some service members have sustained injuries or developed medical conditions as a consequence of military service that affect their ability to perform their military duties.

The process by which the U.S. Department of Defense (DoD) evaluates service members and determines whether they should be medically discharged has changed considerably since 2001. In particular, beginning in 2007, major changes to the Disability Evaluation System (DES) were implemented in response to concern about inefficiencies and confusion resulting from the practice of having DoD and the U.S. Department of Veterans Affairs (VA) conduct separate evaluations according to different criteria, thus producing different disability determinations.

In 2008, DoD launched a pilot program to streamline the disability evaluation process, with VA conducting medical exams to be used by both DoD and VA. This system, the Integrated Disability Evaluation System (IDES), was formally adopted military-wide in 2011. Changes to DES also reflected changes in understanding of traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), the signature injuries of the Iraq and Afghanistan wars. The authors review changes to disability evaluation policy and changes in the diagnosis and treatment of PTSD and TBI since 2001.

Key Findings

Significant reforms were implemented after DES came under increasing scrutiny starting in 2001

  • Between 2001 and 2007, studies found inconsistencies in disability evaluation processes across the services and a lack of DoD-level standardization and oversight.
  • The 2008 National Defense Authorization Act established major changes to DES and laid the groundwork for the move to an integrated disability evaluation system, including an IDES pilot authorization.
  • By 2010, the average time a service member waited for adjudication was cut almost in half under the IDES pilot, and the new system was formally established the following year.

Changes to DES also involved changes in evaluation of service members with PTSD, TBI, or both

  • As of 2008, service members who are determined to be unfit because of PTSD receive a minimum 50-percent disability rating and are placed on the Temporary Disability Retired List for up to five years. (This was changed to three years in 2016.)
  • Since 2009, all deployed service members have been required to complete a mental health assessment before and after each deployment.
  • In 2010, the services were required to assess the impact of a PTSD or TBI diagnosis on service members prior to administratively discharging them for misconduct. By 2015, if service-related PTSD was diagnosed, administrative separation for a personality or mental disorder not constituting a physical disability was disallowed.
  • Starting in 2012, new systems for evaluating PTSD and TBI were implemented in order to improve identification and treatment of these injuries.

Table of Contents

  • Chapter One

    Introduction and Overview

  • Chapter Two

    Evolution of the Disability Evaluation System

  • Chapter Three

    Posttraumatic Stress Disorder and Traumatic Brain Injury: Signature Injuries of the Wars in Iraq and Afghanistan

  • Chapter Four

    Summary and Conclusion

This research was sponsored by the Psychological Health Center of Excellence and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division (NSRD).

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