The question of whether or not a service member with musculoskeletal injuries (MSKIs) will return to duty is a complicated process to answer. And MSKIs significantly impact medical readiness, burden the Military Health System, and contribute to service-connected disability costs. Jeffrey Tiede and Sean Moore question whether the current return to duty process is worth the effort it requires and the resources it consumes while providing unreliable outcomes. Tiede and Moore, based on their respective experiences at the Center for the Intrepid and the San Francisco VA, propose that the process must be reviewed and further developed by experts in complex systems in order to provide a timely and reliable framework for decision.