Session number: 1136
Abstract title: Changes in Service Utilization during Phases of the C&P process for PTSD
Author(s):
MR Spoont - Center for Chronic Disease Outcome Research
NA Sayer - Center for Chronic Disease Outcome Research
D Nelson - Center for Chronic Disease Outcome Research
S Nugent - Center for Chronic Disease Outcome Research
M Murdoch - Center for Chronic Disease Outcome Research
Objectives: Veterans’ difficulties in dealing with the C&P claims process have become a primary focus of VA’s administrative agenda. These difficulties may be intensified for claimants filing for service connection (SC) for posttraumatic stress disorder (PTSD), in part because the PTSD disability examination involves discussing traumatic experiences in a non-therapeutic context. This study looks at whether medical and mental health service utilization changes as a function of phases of the disability evaluation process for PTSD.
Methods: Medical and mental health (MH) service utilization (SU) were extracted from national VA databases for all PTSD claimants from 1997-1999 who were already receiving services at the Minneapolis VAMC. SU was examined at 3 time points: Before an application was filed (Pre-claim), during the disability exam period (Exam), and after receiving notification (Post-claim). C&P exams were excluded.
Results: A total of 771 claimants met inclusion criteria. Claimants used more outpatient MH services during the Exam period than the Pre-Claim period (p<.0001), and used less during the Post-Claim period, though still more than in Pre-Claim period (p<.0001). The increase in SU during the Exam period was greatest in male applicants, those who eventually became SC’d, and those who were in the MH system prior to filing a claim. Female applicants’ MH SU was higher during the Pre-Claim period than males’ SU (p<.0069). Medical SU also increased from Pre-Claim to Exam periods (p<.0001) and remained elevated into the Post-Claim period (p<.0001). This effect was evident in male claimants and those who eventually became SC’d; whereas women and those whose claims were denied showed no change in SU across time periods.
Conclusions: Different phases of the claims process for PTSD were associated with different levels of SU. The increase in MH SU during the Exam period may reflect greater stress during that period. Those who eventually became SC’d showed an exaggeration of this pattern, suggesting that claimants with more severe symptomatology may be more affected by the exam-related stress.
Impact statement: Coordinated interventions between VBA and VHA should be designed to minimize the clinical impact of the disability evaluation process on veterans with PTSD.