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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3066 — Beliefs and Knowledge about the C&P Process Influence Symptoms at the Time of the PTSD C&P Exam

Author List:
Spoont MR (CCDOR)
Sayer NA (CCDOR)
Nelson DB (CCDOR)
Clothier B (CCDOR)
Murdoch M (CCDOR)
Nelson S (CCDOR)

Objectives:
The compensation and pension (C&P) claims process for posttraumatic stress disorder (PTSD) is important to veterans, and many experience the process as stressful. We were interested in understanding the impact of the process on claimants, and to what extent beliefs and knowledge about the process contributed to claimants’ clinical status.

Methods:
We used a within-subject prospective design to look at the impact of beliefs and knowledge about the C&P process on physical and psychiatric symptoms and disability level in 108 veterans who filed original PTSD C&P claims in the Upper Midwest. Symptoms and disability level were assessed by questionnaires immediately following claim submission and within 24 hrs before the disability examination. Multiple regression analyses were used to predict the relative impact of beliefs and knowledge on symptoms and disability at the time of the examination while controlling for significant demographic variables and baseline values.

Results:
PTSD and depression symptoms, physical complaints and disability level all increased immediately preceding the C&P examination relative to levels at the time of claim submission. Negative expectations significantly contributed to exam-related PTSD and depression symptoms. Felt importance of the obtaining service connection (SC) contributed to exam-related physical symptoms. Overall disability level at the time of the exam was influenced by negative expectations, felt importance of obtaining SC, and knowledge about the process. Demographic variables related to exam-related worsening were income, education and employment status.

Implications:
Psychiatric and physical symptoms and overall disability level are exacerbated by participation in the PTSD disability examination process. The degree of exacerbation is influenced by beliefs and knowledge about the disability claims process. Understanding the impact of beliefs about the claims process on symptom severity may help both disability examiners in their understanding of claimants’ presentations, and treating clinicians who may need to provide added support to veteran claimants at this crucial juncture in the claims process.

Impacts:
These findings may help the development of appropriate interventions to improve the claims process and to assist veterans with PTSD who file disability claims.


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