Exploring Disparities in Awarding VA Service-Connected Disability for Post-Traumatic Stress Disorder for Active Duty Military Service Members from Recent Conflicts in Iraq and Afghanistan.

INTRODUCTION We explore disparities in awarding post-traumatic stress disorder (PTSD) service-connected disability benefits (SCDB) to veterans based on gender, race/ethnicity, and misconduct separation. METHODS Department of Defense data on service members who separated from October 1, 2001 to May 2017 were linked to Veterans Administration (VA) administrative data. Using adjusted logistic regression models, we determined the odds of receiving a PTSD SCDB conditional on a VA diagnosis of PTSD. RESULTS A total of 1,558,449 (79% of separating service members) had at least one encounter in VA during the study period (12% female, 4.5% misconduct separations). Females (OR 0.72) and Blacks (OR 0.93) were less likely to receive a PTSD award and were nearly equally likely to receive a PTSD diagnosis (OR 0.97, 1.01). Other racial/ethnic minorities were more likely to receive an award and diagnosis, as were those with misconduct separations (award OR 1.3, diagnosis 2.17). CONCLUSIONS Despite being diagnosed with PTSD at similar rates to their referent categories, females and Black veterans are less likely to receive PTSD disability awards. Other racial/ethnic minorities and those with misconduct separations were more likely to receive PTSD diagnoses and awards. Further study is merited to explore variation in awarding SCDB.

[1]  Paulette T. Cazares,et al.  Sexual Assault and Disabling PTSD in Active Duty Service Women. , 2018, Military Medicine.

[2]  Ian J. Stewart,et al.  Associations of Initial Injury Severity and Posttraumatic Stress Disorder Diagnoses With Long-Term Hypertension Risk After Combat Injury , 2018, Hypertension.

[3]  M. Samore,et al.  Non-routine Discharge From Military Service: Mental Illness, Substance Use Disorders, and Suicidality. , 2017, American journal of preventive medicine.

[4]  W. Halperin,et al.  The Health and Social Isolation of American Veterans Denied Veterans Affairs Disability Compensation. , 2017, Health & social work.

[5]  W. Halperin,et al.  Health and Health Care Service Utilization Among U.S. Veterans Denied VA Service-Connected Disability Compensation: A Review of the Literature. , 2015, Military medicine.

[6]  Matthew H Samore,et al.  Military Misconduct and Homelessness Among US Veterans Separated From Active Duty, 2001-2012. , 2015, JAMA.

[7]  Eric Elbogen,et al.  The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans: a meta-analysis. , 2015, Journal of anxiety disorders.

[8]  Han K. Kang,et al.  PTSD diagnoses among Iraq and Afghanistan veterans: comparison of administrative data to chart review. , 2014, Journal of traumatic stress.

[9]  Heidi L. W. Golding,et al.  Veterans' Disability Compensation: Trends and Policy Options , 2014 .

[10]  R. Rosenheck,et al.  Gender differences in VA disability status for PTSD over time. , 2014, Psychiatric services.

[11]  Nina A. Sayer,et al.  Impact of treatment beliefs and social network encouragement on initiation of care by VA service users with PTSD. , 2014, Psychiatric services.

[12]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[13]  R. McNally,et al.  Why are Iraq and Afghanistan War veterans seeking PTSD disability compensation at unprecedented rates? , 2013, Journal of anxiety disorders.

[14]  K. Seal,et al.  Post Deployment Care for Returning Combat Veterans , 2012, Journal of General Internal Medicine.

[15]  Nina A. Sayer,et al.  A qualitative study of U.S. veterans' reasons for seeking Department of Veterans Affairs disability benefits for posttraumatic stress disorder. , 2011, Journal of traumatic stress.

[16]  Nina A. Sayer,et al.  Long-term outcomes of disability benefits in US veterans with posttraumatic stress disorder. , 2011, Archives of general psychiatry.

[17]  P. Schnurr,et al.  Variation in practices and attitudes of clinicians assessing PTSD-related disability among veterans. , 2011, Journal of traumatic stress.

[18]  D. Kansagara,et al.  Interventions to Improve Minority Health Care and Reduce Racial and Ethnic Disparities , 2011 .

[19]  B. Shiner,et al.  Strategies to improve compensation and pension timeliness: lessons learned from high-performing facilities. , 2010, Military medicine.

[20]  A. Surís,et al.  Military Sexual Trauma , 2008, Trauma, violence & abuse.

[21]  M. Freeman,et al.  Racial and Ethnic Disparities in the VA Healthcare System a Systematic Review , 2007 .

[22]  N. Sayer,et al.  Regional Variation and Other Correlates of Department of Veterans Affairs Disability Awards for Patients With Posttraumatic Stress Disorder , 2005, Medical care.

[23]  N. Sayer,et al.  Veterans seeking disability benefits for post-traumatic stress disorder: who applies and the self-reported meaning of disability compensation. , 2004, Social science & medicine.

[24]  N. Kressin,et al.  Gender Differences in Service Connection for PTSD , 2003, Medical care.

[25]  Larry Fortier,et al.  Time, gender, and regional trends in the application for service-related post-traumatic stress disorder disability benefits, 1980-1998. , 2003, Military medicine.

[26]  M. van Ryn,et al.  Racial Disparities in VA Service Connection for Posttraumatic Stress Disorder Disability , 2003, Medical care.